Posted by Scott Greenstone from Ogilvy Health North America on January 9, 2019

Overview of the EHR Industry Fragmentation

EHR adoption began to take hold amongst HCPs back in 2009 with the implementation of the American Recovery and Reinvestment Act, which included a push to digitize patient records. This was accomplished through the Health Information Technology for Economic and Clinical Health (HITECH) Act, by providing incentives to HCPs and practices for implementation and adoption of EHRs.

Beginning in 2011, utilizing a three-stage approach, HITECH incentivized providers over the span of five years. Many of you may know this as the Meaningful Use program where providers demonstrated how they were using EHRs in a meaningful way. If they successfully met the requirements of each stage, they were rewarded through financial incentives.

Despite being adopted by more than 80% of office-based physicians, the interoperability of these systems is still lacking.

Fast-forward seven years and the success of HITECH is still unclear. Despite being adopted by more than 80% of office-based physicians, the interoperability of these systems is still lacking. Many of today’s systems are unable to share patient data from one system to another in a productive and usable manner. This is most likely a direct result of poorly aligned incentives, where provider rewards were focused on EHR adoption and not on health information exchange (HIE). In addition to providers not being properly incentivized for HIE, EHR vendors were also not properly incentivized to make their application communicate easily with other systems.

Despite hundreds of EHRs being certified by the federal government, each one is unique, offering different terminology, technical specifications, and even functional capabilities. These differences make it difficult for systems to implement a standardized format in order to share data.

Because of misdirected legislation, incentives and guidance, the EHR industry continued to remain fragmented with over 600 different systems. These systems became embedded into practices and hospital systems, making it extremely difficult and costly to switch to a new system.

As mentioned above, there are over 600 EHR systems, and all have issues with communicating with each other. There are physicians who can be using three or more systems in any given day when working in the office, hospital and surgery centers.

Hospitals can be even more fragmented due to the recent trends in facility consolidation. As a result, hospital systems can be running 16 or more unique EHRs across the network. This makes management and support of EHRs much more complicated, as administration needs to figure out how to make all of these systems work together.

There are physicians who can be using three or more systems in any given day when working in the office, hospital and surgery centers.

The majority of EHRs have similar capabilities, but where they are in the system and how they are used can differ dramatically. Providers are resistant to changing which system they use due to the amount of effort they put in to customize and learn the system they use. In addition, from a Meaningful Use standpoint, providers can often be penalized for technological issues that are not within their control. This lends to the resistance of change by the providers as they want to remain with what they are comfortable with and not switch to a new system that may result in further Meaningful Use penalties.

Fragmentation is also a result of increased costs for switching systems. Despite the continual change in the EHR industry, smaller practices lack the funds or technical know-how to implement a new system. Vendors that provide cloud-based ease of implementation make this process simpler for the practices, but the result perpetuates the fragmentation and large number of available systems to choose from.

Overcoming Fragmentation

Many of the EHR systems allow pharma messaging, whether a banner message, clinical message, financial messaging, or even enrollment assistance. With such a large number of potential outlets, it can be a daunting task if you had to work with each system individually to get messages placed and receive analytic data to support your campaigns.

From a marketing standpoint, the fragmentation in the industry has led to the creation of a few organizations that we refer to as aggregators. These aggregators have put together a process and a technological framework that allows us to work with a handful of partners to place a variety of message types in almost 500 EHR platforms. They have successfully decreased the number of conversations that need to occur in order to message to the largest possible HCP audience.

These aggregators are continually adding new EHR partners to expand their reach, while at the same time constant consolidation of EHRs through mergers and buyouts is working to reduce the marketing barriers due to the industry fragmentation. We are constantly seeking new partners, both here in the US as well as abroad, to help provide the best marketing strategies for our clients. In addition to our proactive industry research to find and develop new partnerships, we also spend time at conferences, such as HIMSS, to learn about new companies, products, and offerings that can enhance our strategic recommendations.

It’s important to keep in mind this industry fragmentation as it can be a cause of delay for various EHR messaging aspects including analytics, message propagation, and even match list requests.